[Clinical aspects, diagnosis and therapy of insect bite allergy]

Systemic allergic reactions following insect stings, most often by hymenoptera (honey bee, wasp), are usually of the immediate type and thus mediated by venom specific IgE-antibodies. The most frequent clinical symptoms are urticaria, angioedema, asthma and anaphylactic shock. While in epidemiological surveys up to 4% of individuals report a history of systemic allergic reactions following hymenoptera stings, fatal cases are extremely rare. Diagnosis is based on history, skin tests and estimation of venom specific serum IgE-antibodies (RAST). For treatment of mild systemic reactions antihistamines are often sufficient. In all cases with respiratory and/or cardiovascular symptoms, adrenalin must be given either by inhalation or by injection. All patients with a history of systemic reactions to hymenoptera stings must be instructed in prophylactic measures and receive emergency medication including adrenalin. The efficacy of venom immunotherapy is well documented but this treatment is expensive. It is therefore mainly indicated in patients with a history of sever systemic reactions and a high degree of exposure.